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Adjunctive vancomycin powder in pediatric spine surgery is safe
Itai Gans1, John P Dormans, David A Spiegel
1*The Children's Hospital of Philadelphia, Philadelphia, PA; and †The Hospital of The University of Pennsylvania, Philadelphia, PA.
Insights
This study found that using vancomycin powder (VP) during pediatric spine surgery did not cause significant changes in kidney function or systemic levels. Intraoperative VP is a safe option for preventing surgical site infections in children.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease Prevention
- Spine Surgery
Background:
- Surgical site infections (SSIs) are a concern in pediatric spine surgery, particularly those caused by methicillin-resistant Staphylococcus aureus.
- Vancomycin powder (VP) is used in adults to reduce SSIs, but its safety in pediatric patients is not well-documented.
- This study addresses the need for safety data on VP in pediatric spine surgery.
Purpose of the Study:
- To evaluate the safety of adjunctive local vancomycin powder (VP) application for infection prophylaxis.
- To assess VP's safety in posterior instrumented thoracic and lumbar spine wounds in pediatric patients.
- To determine the impact of VP on kidney function and systemic levels in pediatric patients.
Main Methods:
- A Level II cohort study reviewed data from 87 pediatric patients weighing over 25 kg undergoing spine deformity correction.
- 500 mg of unreconstituted VP was applied locally during surgery, alongside routine intravenous cephalosporin prophylaxis.
- Creatinine levels and systemic vancomycin levels were monitored preoperatively and on postoperative days 1 and 4.
Main Results:
- No significant changes in creatinine levels were observed postoperatively.
- Systemic vancomycin levels remained undetectable in all patients.
- No instances of nephrotoxicity or Red Man Syndrome were reported.
- Three out of 87 patients developed a surgical site infection.
Conclusions:
- Intraoperative vancomycin powder (VP) is safe for infection prophylaxis in pediatric spine surgery.
- VP does not cause clinically significant changes in renal function or systemic levels in this patient population.
- VP can be considered a safe adjunct for reducing SSIs in pediatric spine deformity procedures.
Study Design:
Therapeutic level II cohort study.
Objective:
To evaluate the safety of adjunctive local application of vancomycin powder (VP) for infection prophylaxis in posterior instrumented thoracic and lumbar spine wounds in pediatric patients weighing more than 25 kg.
Summary Of Background Data:
Spine surgeons have largely turned to vancomycin prophylaxis in an attempt to decrease the incidence of late surgical site infection and acute surgical site infection from methicillin-resistant Staphylococcus aureus. In adult patients, the adjunctive local application of VP with an intravenous cephalosporin has been shown to decrease postsurgical wound infection rates significantly; however, the safety of VP as an adjunct in pediatric spine surgery has not been reported.
Methods:
We reviewed data collected under a systematic protocol specifically designed to monitor the safety profile of VP. We measured changes in creatinine and systemic vancomycin levels after intrawound application of 500 mg of unreconstituted VP during spine deformity correction surgery in patients weighing more than 25 kg (patients also received routine intravenous cephalosporin prophylaxis). Laboratory values were measured preoperatively and on postoperative days 1 and 4. Any adverse reactions and infections through available follow-up (2-8 mo) were recorded.
Results:
Eighty-seven consecutive pediatric patients with spinal deformity weighing more than 25 kg who received intraoperative VP during a 9-month period were identified. Sixty-three percent of the patients in this series had adolescent idiopathic scoliosis, 15% congenital scoliosis, 15% neuromuscular scoliosis, and 5% spondylolisthesis. The average change in creatinine levels between the preoperative and postoperative day 1 draw was -0.03 and between the preoperative and postoperative day 4 draw was -0.075. The postoperative systemic vancomycin levels remained undetectable. None of the patients experienced nephrotoxicity or red man syndrome. Three of the 87 patients developed a surgical site infection.
Conclusion:
In this cohort there were no clinically significant changes in creatinine level or systemic vancomycin level caused by use of intraoperative VP.
Level Of Evidence:
2.
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